In summary

Faced with a myriad of social pathologies, California will try a new approach – a more integrated and aggressive treatment.

As it faces the stubborn COVID-19 pandemic, California also grapples with an assortment of equally resilient social pathologies, including chronic disease, homelessness, poverty, drug and alcohol addiction, mental illness and street crime.

State and local governments have created programs to mitigate the effects of these diseases, but they generally operate in silos, each targeting a particular condition without overt coordination with the others, even though the people they serve very often have multiple issues. .

For example, a homeless person not only has no shelter, but is poor and likely to have medical problems and suffer from mental illness, alcoholism and/or drug addiction involving the criminal justice system.

Moreover, official approaches have been largely passive, offering patients opportunities to improve their lot but, except in rare circumstances, not compelling them to cooperate.

The 2022-23 state budget that Governor Gavin Newsom proposed last week indicates that the state will begin to approach chronic social problems differently, integrating services with the goal of “whole person care, by intervening more aggressively and, in some cases, supporting those whose lives are spiraling out of control.

The centerpiece of this new approach is called “California Advancing and Innovating Medi-Cal” or CalAIM for short, which Newsom celebrated as a “once-in-a-generation opportunity to completely transform the (Medi-Cal) system in California.” when he signed the enabling legislation. Medi-Cal, California’s medical care system for the poor, has more than 14 million enrollees, or more than a third of the state’s residents.

CalAIM is described in the budget as “a framework that encompasses a broad delivery system, program, and payment reform across the Medi-Cal program (which) recognizes the opportunity to evolve the overall approach to health care. the person who integrates health care and other social services. determinants of health, statewide with a clear focus on improving health and reducing health disparities and inequities, including improving and expanding health care behavioral.

“Previous research indicates that the most expensive enrollees (Medi-Cal) are typically treated for multiple chronic conditions (such as diabetes or heart failure) and often suffer from mental health or addictions issues,” said the Legislative Budget Advisor Gabe Petek. said in a CalAIM analysis. “Costs for this population are often driven by frequent hospitalizations and high prescription drug costs. In some cases, social factors such as homelessness play a role in the high use of these enrollees.

With Medi-Cal serving such a large portion of the state’s population, CalAIM could have a massive societal effect — especially since it envisions a much broader role. For example, insurance companies and other Medi-Cal providers will assign personal care managers to their clients, not only to monitor their medical care, but to improve other aspects of their lives, such as housing. and income support.

The state’s new approach will also affect California’s criminal justice system, which has moved away from punishment and toward rehabilitation over the past decade. Newsom also proposes that before being released from prison, inmates be enrolled in Medi-Cal and thus benefit from a wider range of support services.

This automatic registration is emblematic of the more militant or intrusive attitude that Newsom advocates and another example could be a huge change in mental health. During his budget press conference, he again hinted that he wanted to subject people with serious mental illnesses to a process of “conservation” that could compel them to be housed and cared for, rather than allowing them to wander the streets.

These are huge shifts in direction in medical and social services from a state that does not have a positive track record of running high-concept policies. We can only wait to see if it works.